Deadly clashes over the weekend in the Democratic Republic of the Congo's (DRC's) main Ebola hot spot between rebels and armed forces suspended outbreak response activities, as six new cases were reported and more details emerged about a recent case detected near the Uganda border.

The violence in Beni on Saturday has killed 21 people, 17 of them civilians, with the DRC's army blaming the Allied Democratic Forces, a rebel militia, Agence France-Presse (AFP) reported today. The country's health ministry asked aid groups working in Beni to temporarily suspend their activities, but Doctors Without Borders (MSF) Ebola treatment centers located 20 to 30 miles outside the city were operating normally, the report said.

Problems in Beni, where outbreak responders are already grappling with pockets of community resistance to steps such as contact tracing, vaccination, and medical treatment, come 3 months before an election to replace Joseph Kabila, the DRC's controversial president.

In a statement yesterday, the health ministry said many residents took to the streets to protest growing insecurity in the area, adding that response activities will resume as soon as calm returns to the city.

Ebola death toll hits 100

The 6 new confirmed cases include a case in Tshomia in Ituri province near the Ugandan border that was recently reported by the news media, 4 from Beni, and 1 from Mabalako, according to DRC health ministry updates posted Sep 21, 22, and 23.

Also, the number of deaths reached 100 with the addition of 3 fatalities reported in Beni, Tshomia, and Butembo.

The new cases boost the DRC's Ebola total to 149 cases, 118 of them confirmed. Also, health officials are investigating 12 suspected infections.

Patient flees to unsecured health zone

In another worrisome development, the DRC's health ministry said yesterday that a confirmed case-patient in Beni escaped a hospital before being transferred to an Ebola treatment center. The patient was found in an unsecured part of Kalunguta health zone.

Ebola patient who evade treatment pose a major risk of spread, and the threat of the disease moving to an non-secure area poses an extra threat to responders and adds to the already difficult task of containing the virus.

Discussions are under way with the village chief and the health zone's management team to safety retrieve the patient, the health ministry said.

Tshomia patient tied to resistant district

The Ebola case detected near the Ugandan border, noted earlier media reports, involves a known contact of the first confirmed case in Beni's Ndindi district, which has been a flash point for community resistance against response efforts, the health ministry said in its Sep 21 daily update. The first patient in Ndindi died in the community, and the woman wasn't buried securely.

Some of her relatives refused to cooperate with health responders, which led to several confirmed cases and deaths in the same family. When their symptoms began, they fled to other health areas, including Mabalako, Masereka, Butembo, and Tshomia. "Thus, all the first confirmed cases in these areas are direct contacts of the case of Ndindi district," the health ministry said.

Outbreak coordinators sent teams to all the areas within the first 24 to 36 hours to quickly identify and vaccinate contacts surrounding the patients, the ministry said, adding, "These rapid interventions are necessary to rapidly break the chain of transmission related to Ndindi's resistance."

On Sep 21, a joint team that included vaccinators, experts in infection prevention and control, and an emergency physician was deployed to Tshomia health zone, and the next day vaccination of the first contacts of the patient confirmed there began. The ministry said that so far 56 contacts have already voluntarily registered with vaccination teams.

The health ministry said 10 people in Tshomia have been vaccinated, bringing the overall total in the outbreak to 11,417. In its update on Sep 21, the health ministry said 4,320 more doses of the experimental VSV-EBOV vaccine have arrived in Kinshasa.